I Never Met a Paranoid Schizophrenic I Didn’t Like takes the reader on a twenty-year journey through state mental hospitals, a maximum security prison psychiatric unit, an institution for the mentally challenged, and two outpatient mental health centers. The author, a psychologist who comes from a dysfunctional family himself, reveals his growth as a person and professional as he treats people with such diverse illnesses as schizophrenia, bipolar disorder, kleptomania, obsessive compulsion, sociopathic personality, paranoia, and multiple personality, among others. Gradually he becomes aware that much of what he learned in graduate school does not apply to the real world of mental illness, and necessary adjustments begin to be made. “The words I now put on paper constitute a memorial for the patients who came and went, and for the young psychologist who wanted to heal them all. He arrived believing he knew a lot, and emerged years later realizing that the door to understanding had only been cracked.” And yet the knowledge came, to the benefit of those he treated, and, ultimately, to himself.
His name is David. Six feet, two inches tall and two hundred and forty pounds. His brown hair is thinning. He walks with a ponderous tread, shoulders bent, eyes cast down. He barely communicates. During the first ten minutes of the interview he sits hunched over in the chair breathing laboriously and grimacing. It appears he wishes to speak but cannot gather his thoughts, and is frustrated by this verbal impotence.
I lean back in my chair and put my feet on the desk. “Take your time,” I say softly. “I’ve got all day.”
This is true. The mental health center where the interview is taking place is a fledgling operation and David will be my only patient today. So we sit for a while and relax. Gradually I learn that he is forty-six and has been hospitalized ten times in the past twenty-four years for violent schizophrenic episodes. His last hospitalization was about twelve months ago, but now he is once again sliding back into psychosis and is desperate for help.
David is an interesting man, certainly more interesting than the typical schizophrenic I have met over the years. He graduated as salutatorian of his high school class in the late ‘40’s where he was also a basketball star, then entered the University of North Carolina at Chapel Hill with the intention of becoming a mathematics major. But already the illness was eating away at his cognitive processes, and before the first semester had elapsed, he realized he was unable to concentrate on the problems at hand. He dropped out of school and went home to help his father on the farm. As the years progressed his condition deteriorated, and finally he was forced to admit himself to Dorthea Dix Hospital in Raleigh, the state institution for the mentally ill. Hallucinations were now dominating his life.
What makes David interesting is his awareness of his own illness and his willingness to confront it. Schizophrenics have a peculiar way of ignoring their symptoms and being resistive to treatment. However, David has been paralyzed by his illness and unable to carry out any kind of constructive activity. Voices constantly call him filthy names and force him to perform humiliating acts. “Sissy!” they call him. “Queer! Stupid! Why don’t you kill yourself? You’re no good to anybody! You might as well be dead!”
He fights back, cursing, shaking his fist. “Leave me alone, goddamn it! Leave me alone!” But this only makes things worse, evoking heavy condemnation. “You’re going to hell for cursing,” the voices mock him. “You’re going to hell for cursing.”
Plagued with guilt, he appeals to God for forgiveness. “Please send them away,” he begs. “Please send them away.”
Sometimes he prays and curses in the same breath.
There is no escape.
At the mental institution the staff tried to help all they could. The nurses especially were understanding and sensitive to his sufferings, but were limited in their options. He underwent numerous electroshock treatments, and even the very primitive insulin shock therapy of the time. All medications were tried, and as new ones came on the market they were thrown into the regimen. Nothing worked. He would improve for a while and be sent home, only to deteriorate again and be re-admitted. The longest period he spent in the hospital was sixteen months, the shortest, six months. Once, in desperation, he attended a faith healing revival held by the evangelist Oral Roberts. The great man touched his head and attempted to cast out the demons, but to no avail. The voices screamed at him, cursing more violently than ever.
It was a never-ending nightmare . . .
However, I believe I can help this man where others have failed. I have studied schizophrenia for years and understand the disease. I know it is biochemical but also suspect that there are psychological components that can be addressed to ease the symptoms overall. Give the patient tools to fight the terrible hallucinations and all the havoc they render and this in itself will improve the situation. And medication – the proper medication needs to be determined. This is mandatory. I know there is always a best-medication combination– the mix that reduces the symptoms by the maximum amount with the least side effects.
I have been searching for a patient like David for a long time to test my theories. He possesses three qualities I consider invaluable: 1. Intelligence 2. Awareness that his hallucinations are, indeed, hallucinations and not real people talking to him 3. A willingness to fight.
“Why don’t you come in and see me on a regular basis for a while?” I suggest after two hours. “I think I can help you.”
He regards me skeptically. I later learn that he thinks I look awfully young, awfully inexperienced. “Okay. How often should I come?”
“Let’s start off at three times a week. Let’s really hit this thing hard. I’ve got the time. Can you come in that often?”
“Sure. What else have I got to do?”
“Come in this Friday first and see the psychiatrist and we’ll get your medications straight. Then we’ll go from there.”
He visits the psychiatrist on Friday, and we fiddle with his medication over the next three months until we fall on the right combination. That in itself helps. He starts coming to the center in the early afternoons on Mondays, Wednesdays, and Fridays, for therapy. My plan is to start slowly and drift into the core of his illness. I have a library of reference books at home and can consult them whenever needed. I feel all these preparations are more than adequate for the task at hand, and have little doubt I can handle whatever comes up.
I am wrong.
His illness explodes on me like a titanic bomb. Fifteen minutes into the first session he throws himself to the floor and begins screaming. His head twists to the side as though being wrenched by some macabre spirit, and his eyes roll up out of sight. “Get off me! Get off me!” he hollers, and writhes with what seems like an epileptic seizure. He wails and covers his head with his hands. He rises on all fours and shakes himself violently, like a dog trying to expel flames from its fur, all the while making strange guttural sounds. Then he returns to the floor and curls into a fetal position, moaning quietly, apparently exhausted by his exertions.
I am speechless and I contemplate what to do. The books don’t say anything about this kind of behavior when you are treating someone on an outpatient basis. How many books on schizophrenia have I read? A dozen? Fifty? A hundred? What have I missed? How many experts have I consulted? How many seminars have I attended? Eleven years I’ve spent preparing myself and now I sit here completely impotent, confused, and even frightened. I’m like a graduate student seeing his first patient. I’m clueless.
Eventually he recovers, and slowly picks himself up from the floor and sits back in his seat. He is obviously shaken by the experience, and gives the appearance of a trauma victim. He lets out a deep sigh and stares down at his hands.
“Tell me what happened,” I say.
His eyes are twin pools of pain. “I’m ruled by demons,” he replies.
And so we begin.
This memoir can be published on Amazon.com here.